| NPI | 1982206736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 21254) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30369) |
| 225100000X Physical Therapist (Licence: FL PT36389) | |
| 225100000X Physical Therapist (Licence: NC P23620) | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2026-06-21 |